Cigna Healthcare is taking steps to significantly expand its personalized care management programs, leaning on AI to identify risks sooner and simplify the patient journey.
Through the initiative, Cigna's care teams use predictive analytics to identify individuals who may benefit from supports or intervention earlier, which can avert more negative outcomes or disease progression down the road.
The insurer also deploys its more than 1,250 clinicians, including nurse managers and behavioral health professionals, to guide the care journey. They are empowered to coordinate care between providers and point members to supports available through their health plan that may be beneficial.
Cigna said that it expects to reach 20% more members with emerging or complex health needs through the expanded program, with supported disease states including cancer, heart disease, kidney disease, high-risk pregnancy and behavioral health conditions.
Stanley Crittenden, M.D., chief medical officer at Cigna Healthcare, told Fierce Healthcare in an interview that as healthcare becomes more and more complex, the need for more personalized care pathways and supports becomes even more crucial.
Identifying patients at risk for developing or worsening a complex disease more quickly "will make a much more meaningful difference clinically and financially," he said.
"We think these enhancements will bring care and support to people at the right time," he added.
For example, Cigna expects these care management programs to reduce medical costs for engaged patients by an average of $2,000 each year, leading to $200 million in projected savings total for the next three years.
In addition, the care management programs have also shown promising results to date, including a 42% decrease in avoidable inpatient stays. They've also accelerated the identification of potential breast, colon and lung cancer diagnoses by 55 days, 46 days and 37 days, respectively.
Nearly three-quarters (72%) of members with depression who were connected to behavioral health experts saw a clinically meaningful improvement in their systems, Cigna said.
The care management programs also carry a 95% customer satisfaction rate among those surveyed, the insurer found.
Crittenden said that making strides in the member experience in these programs pays off in the clinical piece.
"We want to make sure they’re experiencing our programs, our systems, our processes in a positive way," he said.
While AI underpins the enhancements to the care management programs—making it easier for the clinical teams to personalize interactions and surface valuable supports—human touch is still at the center of the initiative, Crittenden said.
Having someone they can easily reach by phone, text or digitally is sometimes all it takes to get the patient on the right path, he said.
"Ultimately, healthcare is a business of people taking care of people," said Crittenden.